Healthcare Provider Details

I. General information

NPI: 1639113996
Provider Name (Legal Business Name): NARESH K GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-1100
US

IV. Provider business mailing address

6308 DAKOTA DR
PLANO TX
75024-6011
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2504
  • Fax: 253-968-1136
Mailing address:
  • Phone: 972-839-0364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberK4073
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: